Opioid agonist therapy (OAT) must be widely disseminated and increased in Ukraine in order to optimize HIV prevention and treatment goals, according to a recent study published in The Lancet.

Ukraine has the second largest HIV epidemic in Eastern Europe and Centeral Asia, accounting for 9% of new infections in the region in 2016.1 The country has an estimated 240,000 people living with HIV and 52% of Ukrainian adults are on antiretroviral treatment.1

The country's epidemic is closely associated with injection drug use, and although antiretroviral coverage has increased in recent years, the high rate of new infections may outpace these gains. Political unrest has greatly affected public health and the economy, meaning the country may struggle to meet the costs of improved treatments for those with HIV, according to the study.2

Researchers at Yale University noted that there is low OAT use among people who inject drugs, and thus aimed to model the effect that an increased OAT scale-up could have on the population.2

They first developed a linear optimization model based on current OAT procurement levels in order to estimate efficiency gains that could be achieved. They also developed a dynamic, compartmental population model of HIV transmission that included both injection and sexual risk in order to estimate the effects of OAT scale-up.2

As it stands currently, with OAT coverage of just 2.7% of people who inject drugs, the researchers found that the number of new HIV infections among this population in Ukraine over the next decade would increase to 58,820 people.2

With optimum allocation of OAT, but without additional increases in procurement, the researchers found that OAT coverage could increase from 2.7% to 3.3%.2 Furthermore, they noted that OAT scale-up to 10% and 20% over 10 years would prevent 4368 and 10,864 new HIV infections, respectively.2

The researchers concluded that OAT must be substantially scaled up in all regions of Ukraine in order to optimize HIV prevention and treatment goals, including increased medication procurement and optimization of dosing.

REFERENCES
  1. HIV and AIDS in Ukraine. Alert: Global Information and Education on HIV and AIDS. https://www.avert.org/professionals/hiv-around-world/eastern-europe-central-asia/ukraine. Accessed Jan 13, 2020.
  2. Tan J, Altice F, Madden L, Zelenev A, et al. Effect of expanding opioid agonist therapies on the HIV epidemic and mortality in Ukraine: a modeling study. The Lancet, Dec 23, 2019. https://www.thelancet.com/journals/lanhiv/article/PIIS2352-3018(19)30373-X/fulltext. Accessed Jan 13, 2020.